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Haematology > Anaemia > Flashcards

Anaemia Flashcards

1
Q

What is the most common type of anaemia?

A

Iron deficiency anaemia

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2
Q

Describe the appearance of RBCs in iron deficiency anaemia?

A

Hypochromic microcytic RBCs

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3
Q

Other than iron deficiency anaemia, what can cause hypochromic microcytic RBCs?

A

Thalassaemia
Anaemia of. chronic disease
Sideroblastic anaemia

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4
Q

How saturated with iron is transferrin in iron deficiency anaemia?

A

15%

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5
Q

Low serum ferritin is always an indication of…?

A

Low RES iron stores

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6
Q

Why might. serum ferritin be normal despite iron deficiency anaemia?

A

In states of inflammation because serum ferritin is an acute phase protein

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7
Q

Describe some physical clinical manifestations of iron deficiency?

A

Koilonychia
Atrophic glossitis
Angular stomatitis
Oesophageal web

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8
Q

What are the possible causes. of iron deficiency anaemia?

A

Dietary iron
Malabsorption
Blood loss

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9
Q

In men and post-menopausal women you must assume that iron deficiency anaemia is caused by what until proven otherwise?

A

GI blood loss

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10
Q

In young women, what is the most common cause of iron deficiency anaemia?

A

Blood loss due to menstruation

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11
Q

What condition can cause GI blood loss resulting in iron deficiency anaemia without GI symptoms?

A

Caecal carcinoma

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12
Q

What conditions can cause GI blood loss resulting in iron deficiency anaemia with GI symptoms?

A

Peptic ulcers
Diveticulitis
Carcinoma of the sigmoid colon

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13
Q

How is iron deficiency anaemia treated?

A

Iron replacement

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14
Q

What tablets can be used to treated iron deficiency anaemia?

A

Ferrous sulphate

Serous gluconate

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15
Q

In what cases might 1G IV iron be used to treat iron deficiency anaemia?

A

Intolerance to oral iron
Lack of. compliance with treatment
Renal anaemia and EPO replacement

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16
Q

What form of anaemia is caused by a failure of iron utilisation where the iron becomes trapped in the RES?

A

Anaemia of chronic disease

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17
Q

What laboratory values would be expected in anaemia of chronic disease?

A 
MCV/MCH is normal
ESR is high
Ferritin is normal or high
Iron is low
Total iron binding capacity is low
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18
Q

What is mean corpuscle volume?

A

Measure of the volume of red blood cells present in an FBC i.e. how big the RBCs are

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19
Q

What is mean corpuscular haemoglobin?

A

Measure of the average mass. of haemoglobin per RBC e.g. what colour the RBC is

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20
Q

Where there is raised ESR in anaemia of chronic disease , what is the appearance of RBCs?

A

Rouleux - stacked coin appearance

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21
Q

What are the causes of anaemia of chronic disease?

A

RES iron blockade where iron becomes trapped in macrophages and raised levels of hepcidin
Reduced EPO response
Depression bone marrow activity due to cytokines

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22
Q

How is anaemia of chronic disease treated?

A

By treating the underlying condition

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23
Q

In what stages of erythropoiesis does haem synthesis take place?

A

Proerythroblast to reticulocyte stage

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24
Q

How many genes exist for the alpha globin genes of haemoglobin?

A

4

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25
Q

How many genes exist for the beta globin genes of haemoglobin?

A

2

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26
Q

On which chromosomes are the alpha globin genes present?

A

Chromosome 16

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27
Q

On which chromosomes are the beta globin genes present?

A

Chromosome 11

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28
Q

How many alpha globin genes need to be missing before significant anaemia occurs?

A

3

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29
Q

How many alpha globin genes need to be missing before asymptomatic anaemia occurs?

A

2

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30
Q

What is the result of four missing alpha globin genes?

A

This is incompatible with life

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31
Q

What is HbH disease?

A

The result of three missing alpha globin chains, causing a relative excess of beta chains which join together

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32
Q

What treatment is required for three missing alpha globin genes?

A

Blood transfusion during periods of stress.

33
Q

In which group of people. is beta thalassaemia more common?

A

People from central countries near the equator

34
Q

What is the name of the condition in which there is at least one missing alpha globin gene?

A

Alpha thalassaemia

35
Q

What type of inheritance is exhibited by major beta thalassaemia?

A

Autosomal recessive

36
Q

Iron overload is not significant in patients with major. beta thalassaemia. T/F?

A

False. - iron overload has a major effect on life expectancy in these patients

37
Q

What is the result of major beta thalassaemia?

A

Inability to make adult haemoglobin
Significant dyserythropoiesis
Transfusion dependent from early life

38
Q

What is the name of the condition in which both copies of the beta globin gene are missing?

A

Major beta thalassaemia

39
Q

In which part of the world is sickle cell anaemia most common?

A

West Africa

40
Q

What type of inheritance is displayed by sickle cell disease?

A

Autosomal recessive

41
Q

In Hb SS sickle. cell disease there is substitution of glutamine for…?

A

Valine

42
Q

In Hb SC sickle. cell disease there is substitution of glutamine for…?

A

Lysine

43
Q

What are the results of sickle cell disease?

A

Haemolysis

Vast-occlusion causing tissue hypoxia and infarction

44
Q

What effect does sickle cell disease have on the brain?

A

Stroke

Moya moya

45
Q

What effect does sickle cell disease have on the lungs?

A

Acute chest syndrome

Pulmonary hypertension

46
Q

What effect does sickle cell disease have on the bones?

A

Dactilytis

Osteonecrosis

47
Q

What effect does sickle cell disease have on the spleen?

A

Hyposplenic

48
Q

What effect does sickle cell disease have on the kidneys?

A

Loss of concentration / infarction

49
Q

What effect does sickle cell disease have on the male GU system?

A

Priapism

50
Q

What effect does sickle cell disease have on the eyes?

A

Vascular retinopathy

51
Q

What effect does sickle cell disease have on the placenta?

A

IUGR

Foetal loss

52
Q

How can crises be prevented in sickle cell disease?

A 
Hydration
Analgesia
Early intervention
Prophylactic vaccination
Antibiotics
Folic acid
53
Q

How can crises be managed in sickle cell disease?

A 
Oxygen
Fluids
Analgesia
Antibiotics
Specialist care
Transfusion
54
Q

What is the lifespan of RBCs in a compensated haemolytic sate?

A

20-100 days

55
Q

What is the lifespan of RBCs in haemolytic anaemia?

A

<20 days

56
Q

What kind of inheritance does hereditary spherocytosis exhibit?

A

Autosomal dominant

57
Q

What are the potential causes of a hyposplenic state?

A

Pneumococcus, meningococcus, haemophillus, immunisations and long term penicillin

58
Q

What type of anaemia is caused by a deficiency of pyruvate kinase?

A

Extravascular haemolytic anaemia

59
Q

Pyruvate kinase deficiency causing extravascular haemolytic anaemia exhibits what kind of inheritance?

A

Autosomal recessive

60
Q

In Glucose 6 phosphate. deficiency there. is. acute haemolysis from. oxidative stress. What kind of inheritance is exhibited in this condition?

A

X-linked recessive

61
Q

Which antibody mediates cold autoimmune haemolytic anaemia?

A

IgM

62
Q

Cold autoimmune haemolytic anaemia can be idiopathic or a result of. infection with…?

A

Mycoplasma

63
Q

Which antibody mediates warm autoimmune haemolytic anaemia?

A

IgG

64
Q

Cephalopsorins can cause severe haemolysis. T/F?

A

True

65
Q

How is warm. autoimmune haemolytic anaemia treated?

A

Stopping any causative drugs
Steroids
Immunosuppression
Splenectomy

66
Q

The red cell life span would have to be decreased to what level before anaemia develops?

A

<15-20 days

67
Q

What is the difference between intravascular and extravascular haemolysis?

A

Intravascular - destruction of RBCs occurring directly in the circulation, almost always pathological
Extravascular- destruction of RBCs occurring with the RES of the spleen, liver and bone marrow which can be physiological

68
Q

What are the possible causes of intravascular haemolysis?

A

Red cell fragmentation syndromes e.g. RBC breakdown by defective mechanical heart valves
ABO incompatible blood transfusion
Malaria
Cold Autoimmune haemolytic anaemia

69
Q

Warm autoimmune haemolytic anaemia causes intravascular haemolysis. T/F?

A

False - it causes extravascular haemolysis

70
Q

What are the secondary causes of cold autoimmune haemolytic anaemia?

A 
Infection - mycoplasma pneumoniae
Infectious mononucleosis
Lymphoproliferative disorders
SLE
RA
Penicillin or other drugs
71
Q

In what type of haemolysis is their anaemia, reticulocytosis, raised unconjugated bilirubin, haemoglobinaemia, haemoglobinuria and haemosiderinuria?

A

Intravascular haemolysis

72
Q

How is warm autoimmune haemolytic anaemia treated?

A

Corticosteroids
Blood transfusion
Folic acid
Splenectomy

73
Q

What are the long-term risks associated with splenectomy?

A

Infection with encapsulated organisms such as streptococcus pneumonia, haemophilia influenzas and neisseria meningitidis

74
Q

Why is folic acid required in the treatment of autoimmune haemolytic anaemia?

A

There is an increased in production of RBCs to try to compensate for haemolysis. This uses up lots of folate, of which the body has very small stores.

75
Q

Macrocytic anaemia is most likely due to…?

A

Vitamin B12 or folate deficiency

76
Q

Microcytic anaemia is most likely due to…?

A

Iron deficiency anaemia

77
Q

Normocytic anaemia is most likely due to…?

A

Haemolytic anaemia or leukaemia

78
Q

Describe the direct Coombs test

A

An IgM antibody is directed at an antibody on the red cell to cause agglutination of the red cells and a clump forms. This indicates the presence of the antibody on the red cell and confirms autoimmune haemolytic anaemia

79
Q

What is the indirect Coombs test used for?

A

To look for the presence of an antibody in the plasma before transfusion

Haematology (6 decks)

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